Risk factors and clinical significance of subcutaneous emphysema after robot-assisted laparoscopic rectal surgery: a single-center experience

Subcutaneous emphysema (SE) is a complication of laparoscopic surgery, potentially resulting in severe respiratory failure. No reports to date have focused on SE during robot-assisted (RA) rectal surgery. We aimed to reveal the risk factors and clinical significance of SE after RA/laparoscopic rectal surgery. We retrospectively reviewed 221 consecutive patients who underwent RA/laparoscopic rectal surgery. The occurrence of SE was evaluated on postoperative radiographs. Laparoscopic surgery was performed in 120 patients and RA in 101. SE developed in 55 (24.9%) patients. Logistic regression analysis identified RA surgery (odds ratio [OR]: 4.89, 95% confidence interval [CI] 2.13–11.22, p < 0.001), higher age (OR: 1.06, 95% CI 1.03–1.11, p < 0.001), lower body mass index (BMI) (OR: 0.79, 95% CI 0.67–0.93, p = 0.004), thinner subcutaneous layer (OR: 0.88, 95% CI 0.79–0.98, p = 0.02), and lateral lymph node dissection (OR: 9.43, 95% CI 2.44–36.42, p < 0.001) as risk factors for SE. Maximum end-tidal CO₂ was significantly higher in the SE than the non-SE cohort (p < 0.001). There was no difference in postoperative complication rate or length of hospital stay. Lower BMI (OR: 0.79, 95% CI 0.62–0.97, p = 0.02) and thinner subcutaneous layer (OR: 0.84, 95% CI 0.71–0.97, p = 0.01) were predictive factors in the RA cohort. SE occurs more frequently in RA compared with laparoscopic surgery. SE has a modest impact on short-term outcomes, but may occasionally cause severe problems. The indication of RA surgery should be considered carefully in high-risk elderly patients.